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Claire Danel - One of the best experts on this subject based on the ideXlab platform.
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Visceral Pleura invasion and lung cancer further clarifications
European Journal of Cardio-Thoracic Surgery, 2004Co-Authors: M Rique, Jalal Assouad, Christophe Foucaul, Claire DanelAbstract:Kang et al. [1] reported that Visceral Pleura invasion (VPI) was a factor of poor prognosis in T2 non-small cell lung cancer (NSCLC). In a previous study [2], we already stressed the poor prognosis of VPI which we also found correlated with more extensive mediastinal lymph node (LN) involvement and decreased survival rates. Contrary to these authors, we observed VPI to be more frequent in case of non-squamous carcinoma (and of adenosquamous carcinoma which others also underline [3]) and in tumours larger than 5 cm. Concerning this latter point there is an unclear area in their paper. In the ‘patient and method’ section, they took into account T2 lesions and in the results they provide lesions measuring more or less than 3 cm. In case of T2 lesions, VPI is present in 100% of tumours 3 cm or less, the tumours without VPI being T1. Perhaps the authors meant 5 cm and this was mistyped: in such case they must add the T1N0 subgroup to the T2 without VPI. The frequency of VPI will probably appear higher for tumours more than 5 cm. Although not observing an increased rate of VPI in the non-squamous NSCLC patients, they postulated that the most probable reason for this was that most lesions were adenocarcinomas and hence located more peripherally. We suggest the same explanation, also available for adenosquamous carcinomas, for lesions larger than 5 cm, the size of which evolves towards the periphery increasing the likelyhood of VPI. Similar to us [2], they suggest as explanation for poor prognosis the rapidity with which NSCLC in a subPleural location invades the Pleura and disseminates throughout the Pleural cavity: pre-formed stomas that connect subPleural lymphatics with the Pleural space could account for the lymphatic and then the systemic dissemination of the exfoliated tumour cells. Developing this explanation further, we also stressed [2,4] the analogy existing between the poor prognosis in case of VPI and that observed when tumour cells are identified in post-thoracotomy Pleural lavage (PTPL). In order to better understand these phenomena, we recently performed two other studies. We first demonstrated [4] that the presence of tumour cells within PTPL appeared correlated with VPI and particularly with the p2VPI subgroup (the one with tumour exposed on the Pleural surface not having yet involved the parietal Pleura). Secondly, we demonstrated in an anatomical study [5] that the lymphatic drainage of the medial portion of the diaphragmatic Pleura travelled through the peritracheobronchial LN chains, so explaining the greater frequency of mediastinal LN involvement observed in case of VPI. We agree with Hang et al. to consider VPI as a potential indication for adjuvant chemotherapy. The role that VPI and parietal Pleural cell reabsorption may play in the evolution of NSCLC is an important and interesting topic. Such pathologic features, which may aid in the selection of patients for adjuvant chemotherapy, require further knowledge and research.
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Visceral Pleura invasion and Pleural lavage tumor cytology by lung cancer a prospective appraisal
The Annals of Thoracic Surgery, 2003Co-Authors: M Rique, Cecile Adoual, Francoise Le Pimpec Arthes, Francoismarie Lhote, Redha Souilamas, J P Hubsch, Claire DanelAbstract:Abstract Background Despite an early-stage diagnosis, lung cancer presenting with Visceral Pleura invasion (VPI) or malignant Pleural lavage cytology (PLC) has a poor prognosis. The purpose of this study was to correlate VPI to malignant PLC. Methods One hundred forty-three consecutive patients scheduled for surgical lung resection having undergone preresectional Pleural lavage cytology were reviewed. There were 121 malignant and 22 nonmalignant lesions. All cases were studied by pathology, histology, previous transthoracic puncture, VPI, and presence of Pleural lymphatic involvement. Results PLC was positive (n = 13) or suspected (n = 5) for malignant cells in, respectively, 10.7% and 4.1% of patients with lung cancer. There was no positive PLC in cases of nonmalignant disease. PLC was positive only in pT2 tumors and almost always when the tumor was exposed on the Pleural surface, thus possibly exfoliating within the Pleural space (12/17 patients, 70.6%; p Conclusions VPI and positive PLC are linked, and the appearance of tumor cells within the Pleural cavity can be explained by tumor desquamation. The role that Visceral Pleura involvement and parietal Pleura reabsorption play in lung cancer is of paramount importance and deserves further research. A better understanding of their relationship could have major implications in the therapeutic management of non–small cell lung cancer.
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Visceral Pleura invasion by non small cell lung cancer an underrated bad prognostic factor
The Annals of Thoracic Surgery, 2001Co-Authors: D Manach, M Rique, Jacques Medioni, Francoise Le Pimpecbarthes, Antoine Dujo, Claire DanelAbstract:Abstract Background . Visceral Pleura invasion (VPI) by non-small cell lung cancer is a factor of poor prognosis. A tumor of any size that invades the Visceral Pleura is classified as T2. Few studies have been conducted concerning the prognostic significance of VPI relative to other staging factors. Methods . Between April 1984 and December 1996, 1,281 patients with T1 (n = 430) and T2 (n = 851) non-small cell lung cancer underwent curative surgical resection. Adjuvant radiation therapy was performed in 455 patients. There were 176 women and 1,105 men aged 30 to 86 years (mean, 60.9 years). Five hundred nineteen pneumonectomies, 742 lobectomies, and 20 segmentectomies were performed. In all patients, a complete mediastinal lymph node dissection was performed. International staging was stage IA and B (n = 697); stage II A and B (n = 247), and stage III A (n = 337). The patients were divided into two groups according to the existence of VPI (group I without, group II with). Both groups were compared with regard to the size of the tumors, histology, associated lymph node involvement, survival rates, and cause of death. Univariate and multivariate analyses were conducted. Results . VPI (group II) was identified in 19.1% of the resected specimens: group I, n=1036; group II, n=245. The VPI was present in only 10% of non-small cell lung cancer 3 cm or less in size, reaching 33% of patients with non-small cell lung cancer larger than 5 cm ( p = 0.0001). Squamous non-small cell lung cancer were significantly less accompanied by VPI (13.5%) than the other histologic categories. The VPI was associated with a higher frequency of N2 involvement (group I=24.6%, group II=33.4%, p = 0.01) and N2 involvement was more extensive (two or more N2 involved stations: group I=8.2%, group II=15.6%, p = 0.003). Actuarial survival rates were 51.8% at 5 years and 33.8% at 10 years in group I (median, 66 months), and 34.6% at 5 years and 27.9% at 10 years in group II (median, 30 months) ( p = 0.000002). Long-term survival rates significantly decreased for larger tumors. Even in patients with N2 stage tumors, the difference of survival curves between the two groups was statistically significant. Cancer-related deaths were more frequent in group II and were mainly caused by distant metastases. By multivariate analysis, Visceral Pleura invasion proved to be a significant independent factor of poor prognosis. Conclusions . The VPI is a factor of poor prognosis. Its frequent association with extensive N2 involvement supports the hypothesis that exfoliated tumor cells are drained through the Pleural lymphatics by the mediastinal lymphatic pathways and then into the bloodstream. The VPI is an important prognostic factor and, as such should stimulate more studies to better select the patients who could benefit from adjuvant therapy.
Yoshihiko Maehara - One of the best experts on this subject based on the ideXlab platform.
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ectopic Pleural thymoma presenting as a giant mass in the thoracic cavity
The Annals of Thoracic Surgery, 2007Co-Authors: Koji Yamazaki, Toshifumi Kameyama, Hidenori Koso, Tetsuzo Tagawa, Tomofumi Yohena, Ichiro Yoshino, Daigo Kawano, Yoshihiko MaeharaAbstract:We describe a rare case of a giant thymoma that developed in the right thoracic cavity, and seemed to originate from the Visceral Pleura. We believe that there have been few reports of thymoma developing from such an unusual origin.
M Rique - One of the best experts on this subject based on the ideXlab platform.
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Visceral Pleura invasion and lung cancer further clarifications
European Journal of Cardio-Thoracic Surgery, 2004Co-Authors: M Rique, Jalal Assouad, Christophe Foucaul, Claire DanelAbstract:Kang et al. [1] reported that Visceral Pleura invasion (VPI) was a factor of poor prognosis in T2 non-small cell lung cancer (NSCLC). In a previous study [2], we already stressed the poor prognosis of VPI which we also found correlated with more extensive mediastinal lymph node (LN) involvement and decreased survival rates. Contrary to these authors, we observed VPI to be more frequent in case of non-squamous carcinoma (and of adenosquamous carcinoma which others also underline [3]) and in tumours larger than 5 cm. Concerning this latter point there is an unclear area in their paper. In the ‘patient and method’ section, they took into account T2 lesions and in the results they provide lesions measuring more or less than 3 cm. In case of T2 lesions, VPI is present in 100% of tumours 3 cm or less, the tumours without VPI being T1. Perhaps the authors meant 5 cm and this was mistyped: in such case they must add the T1N0 subgroup to the T2 without VPI. The frequency of VPI will probably appear higher for tumours more than 5 cm. Although not observing an increased rate of VPI in the non-squamous NSCLC patients, they postulated that the most probable reason for this was that most lesions were adenocarcinomas and hence located more peripherally. We suggest the same explanation, also available for adenosquamous carcinomas, for lesions larger than 5 cm, the size of which evolves towards the periphery increasing the likelyhood of VPI. Similar to us [2], they suggest as explanation for poor prognosis the rapidity with which NSCLC in a subPleural location invades the Pleura and disseminates throughout the Pleural cavity: pre-formed stomas that connect subPleural lymphatics with the Pleural space could account for the lymphatic and then the systemic dissemination of the exfoliated tumour cells. Developing this explanation further, we also stressed [2,4] the analogy existing between the poor prognosis in case of VPI and that observed when tumour cells are identified in post-thoracotomy Pleural lavage (PTPL). In order to better understand these phenomena, we recently performed two other studies. We first demonstrated [4] that the presence of tumour cells within PTPL appeared correlated with VPI and particularly with the p2VPI subgroup (the one with tumour exposed on the Pleural surface not having yet involved the parietal Pleura). Secondly, we demonstrated in an anatomical study [5] that the lymphatic drainage of the medial portion of the diaphragmatic Pleura travelled through the peritracheobronchial LN chains, so explaining the greater frequency of mediastinal LN involvement observed in case of VPI. We agree with Hang et al. to consider VPI as a potential indication for adjuvant chemotherapy. The role that VPI and parietal Pleural cell reabsorption may play in the evolution of NSCLC is an important and interesting topic. Such pathologic features, which may aid in the selection of patients for adjuvant chemotherapy, require further knowledge and research.
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Visceral Pleura invasion and Pleural lavage tumor cytology by lung cancer a prospective appraisal
The Annals of Thoracic Surgery, 2003Co-Authors: M Rique, Cecile Adoual, Francoise Le Pimpec Arthes, Francoismarie Lhote, Redha Souilamas, J P Hubsch, Claire DanelAbstract:Abstract Background Despite an early-stage diagnosis, lung cancer presenting with Visceral Pleura invasion (VPI) or malignant Pleural lavage cytology (PLC) has a poor prognosis. The purpose of this study was to correlate VPI to malignant PLC. Methods One hundred forty-three consecutive patients scheduled for surgical lung resection having undergone preresectional Pleural lavage cytology were reviewed. There were 121 malignant and 22 nonmalignant lesions. All cases were studied by pathology, histology, previous transthoracic puncture, VPI, and presence of Pleural lymphatic involvement. Results PLC was positive (n = 13) or suspected (n = 5) for malignant cells in, respectively, 10.7% and 4.1% of patients with lung cancer. There was no positive PLC in cases of nonmalignant disease. PLC was positive only in pT2 tumors and almost always when the tumor was exposed on the Pleural surface, thus possibly exfoliating within the Pleural space (12/17 patients, 70.6%; p Conclusions VPI and positive PLC are linked, and the appearance of tumor cells within the Pleural cavity can be explained by tumor desquamation. The role that Visceral Pleura involvement and parietal Pleura reabsorption play in lung cancer is of paramount importance and deserves further research. A better understanding of their relationship could have major implications in the therapeutic management of non–small cell lung cancer.
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Visceral Pleura invasion by non small cell lung cancer an underrated bad prognostic factor
The Annals of Thoracic Surgery, 2001Co-Authors: D Manach, M Rique, Jacques Medioni, Francoise Le Pimpecbarthes, Antoine Dujo, Claire DanelAbstract:Abstract Background . Visceral Pleura invasion (VPI) by non-small cell lung cancer is a factor of poor prognosis. A tumor of any size that invades the Visceral Pleura is classified as T2. Few studies have been conducted concerning the prognostic significance of VPI relative to other staging factors. Methods . Between April 1984 and December 1996, 1,281 patients with T1 (n = 430) and T2 (n = 851) non-small cell lung cancer underwent curative surgical resection. Adjuvant radiation therapy was performed in 455 patients. There were 176 women and 1,105 men aged 30 to 86 years (mean, 60.9 years). Five hundred nineteen pneumonectomies, 742 lobectomies, and 20 segmentectomies were performed. In all patients, a complete mediastinal lymph node dissection was performed. International staging was stage IA and B (n = 697); stage II A and B (n = 247), and stage III A (n = 337). The patients were divided into two groups according to the existence of VPI (group I without, group II with). Both groups were compared with regard to the size of the tumors, histology, associated lymph node involvement, survival rates, and cause of death. Univariate and multivariate analyses were conducted. Results . VPI (group II) was identified in 19.1% of the resected specimens: group I, n=1036; group II, n=245. The VPI was present in only 10% of non-small cell lung cancer 3 cm or less in size, reaching 33% of patients with non-small cell lung cancer larger than 5 cm ( p = 0.0001). Squamous non-small cell lung cancer were significantly less accompanied by VPI (13.5%) than the other histologic categories. The VPI was associated with a higher frequency of N2 involvement (group I=24.6%, group II=33.4%, p = 0.01) and N2 involvement was more extensive (two or more N2 involved stations: group I=8.2%, group II=15.6%, p = 0.003). Actuarial survival rates were 51.8% at 5 years and 33.8% at 10 years in group I (median, 66 months), and 34.6% at 5 years and 27.9% at 10 years in group II (median, 30 months) ( p = 0.000002). Long-term survival rates significantly decreased for larger tumors. Even in patients with N2 stage tumors, the difference of survival curves between the two groups was statistically significant. Cancer-related deaths were more frequent in group II and were mainly caused by distant metastases. By multivariate analysis, Visceral Pleura invasion proved to be a significant independent factor of poor prognosis. Conclusions . The VPI is a factor of poor prognosis. Its frequent association with extensive N2 involvement supports the hypothesis that exfoliated tumor cells are drained through the Pleural lymphatics by the mediastinal lymphatic pathways and then into the bloodstream. The VPI is an important prognostic factor and, as such should stimulate more studies to better select the patients who could benefit from adjuvant therapy.
Hiroto Egawa - One of the best experts on this subject based on the ideXlab platform.
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a successful surgical repair of intraoperative pneumothorax and the diffuse dissection of Visceral Pleura during liver transplantation surgery via trans diaphragmatic approach
Surgical Case Reports, 2019Co-Authors: Kei Sakamoto, Akira Ogihara, Shota Mitsuboshi, Hideyuki Maeda, Takako Matsumoto, Tamami Isaka, Masahide Murasugi, Akiko Omori, Yoshihito Kotera, Hiroto EgawaAbstract:Background Pneumothorax during surgery under general anesthesia is a life-threatening situation for the patient because it can progress easily to the tension pneumothorax due to positive pressure ventilation unless appropriate treatments such as inserting a drainage tube in the thoracic cavity are initiated. The authors experienced a case of intraoperative pneumothorax and the diffuse dissection of Visceral Pleura during liver transplantation surgery, and achieved successful repair by a trans-diaphragmatic approach without changing patient’s body position.
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A successful surgical repair of intraoperative pneumothorax and the diffuse dissection of Visceral Pleura during liver transplantation surgery via trans-diaphragmatic approach
SpringerOpen, 2019Co-Authors: Kei Sakamoto, Akira Ogihara, Shota Mitsuboshi, Hideyuki Maeda, Takako Matsumoto, Tamami Isaka, Masahide Murasugi, Akiko Omori, Yoshihito Kotera, Hiroto EgawaAbstract:Abstract Background Pneumothorax during surgery under general anesthesia is a life-threatening situation for the patient because it can progress easily to the tension pneumothorax due to positive pressure ventilation unless appropriate treatments such as inserting a drainage tube in the thoracic cavity are initiated. The authors experienced a case of intraoperative pneumothorax and the diffuse dissection of Visceral Pleura during liver transplantation surgery, and achieved successful repair by a trans-diaphragmatic approach without changing patient’s body position. Case presentation A 66-year-old male with multiple liver and renal cysts caused by autosomal dominant polycystic kidney disease (ADPKD) was admitted to the authors’ hospital for treating the infection of the liver cysts. The infection was unable to be controlled by conservative treatments. Therefore, the patient was planned to undergo living-donor liver transplantation. Intraoperatively, the liver was found to swell markedly and to firmly adhere to the right diaphragm. After the extraction of the liver, because the right diaphragm swelled markedly, pneumothorax was suspected. Chest tube was inserted immediately, and the small incision was made in the right diaphragm. Thoracoscopic observation revealed that (1) the Visceral Pleura of the bottom of the right lung widely expanded like a giant cyst due to the dissection from the lung parenchyma and (2) a large air leakage from a pin hole appeared in the dissected Pleura. After the completion of the liver transplantation, the thoracoscopic leakage-closing operation was performed through the right diaphragm incision. Because the dissection of Visceral Pleura was too wide to perform plication or cystectomy by a stapler or sutures, the dissected Pleura was opened, and absorbable fibrin sealant patches and fibrin glue were put or injected between the lung parenchyma and the Pleura. Although, after being observed postoperatively, prolonged minor air leakage disappeared by a conservative drainage treatment, and the cyst on the bottom of the right lung disappeared on chest computed tomography (CT). Conclusions Although intraoperative pneumothorax and broad dissection of Visceral Pleura during laparotomy is a complicated situation, the authors successfully repaired air leakage via a trans-diaphragmatic approach without changing the patient’s body position
Koji Yamazaki - One of the best experts on this subject based on the ideXlab platform.
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ectopic Pleural thymoma presenting as a giant mass in the thoracic cavity
The Annals of Thoracic Surgery, 2007Co-Authors: Koji Yamazaki, Toshifumi Kameyama, Hidenori Koso, Tetsuzo Tagawa, Tomofumi Yohena, Ichiro Yoshino, Daigo Kawano, Yoshihiko MaeharaAbstract:We describe a rare case of a giant thymoma that developed in the right thoracic cavity, and seemed to originate from the Visceral Pleura. We believe that there have been few reports of thymoma developing from such an unusual origin.
